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44 Cards in this Set
- Front
- Back
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Osteoporosis pathophys |
age gender race lifestyle drugs increase osteoclastic decrease osteoblastic osteopenia decrease in BMD changes in skeletal structure increase risk fracture, hip, spine, wrist |
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osteoporosis cm |
back pain loss of height stooped posture easier to get bone fracture |
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Osteoporsis lab and dx |
no definitive lab test -biochemical markers sensitive to bone changes BSAP, BMD, Bone density |
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osteoporosis medical interventions |
drug therapy ca 1200-12500 vit d 800-1000 estrogen and hormone therapy biphosphonates, ibandronate |
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nursing intervention osteoporosis |
-teach fr med adminsitration -nutrition therapy: protein, mg, ca, vit k, vit d, trace minerals -exercise -stop smoking, home issues |
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Connective tissue disease |
46 million people in US have at least one or more than 100 types of CT disease or arthritis -arthritis: inflammation of one or more joints inflam: RA and SLE non: OA systemic: gout |
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osteoarthritis pathophys |
enzymes breakdown matrix and proteoglycans cannot manage fluid in joints increase in cartilage loss and thinning -cartilage erodes, joint space narrows, oestophytes develop, inflam response, enhanced deterioration -subluxation deformities leading to TJR |
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nursing assesment arthrist |
OA and RA may look similar joint pain stiffness: intensifies post physical activity, decrease post rest -skeletal muscle atrophy -vertebral column changes -joint changes: heberdens, bowchards nodes -joint effusions: crepitus |
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arthritis labs and dx |
xray: structural joint changes MRI: vertebral or knee involvemnet |
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OA conservative pain management |
pain: low and slow 1 tylenol, lidocaine 2 nsaids, cox2 opiods 3 joint injections 4 thermal therapy 5 diet 6 integrative therapies 7 physical therapy |
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OA surgical management arthroplasty |
purpose: pain is no longer in control, loss of ADL, quality of life -hips and knees most common -total joint arthroplasty or replacement contraindicated: infection, osteoporosis, rapidly progressive inflammation |
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arthroplast nursing medical pre op care |
pain management encourage autologous transfusions collaborative consulations assess for safety issues hemodynamic and electrolyte status |
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arthroplasty post op care |
neurovascular assesmnet 6P's pain managemnt anticoagulant activity progression continous passive motion: only knee |
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arthroplasty prevent infection |
temo wind: is this atelectasis or pneumonia wound: look, no infection water: UTI walking wonder drugs |
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arthroplasty complication: dislocation |
abduction pillow (hip) -do not sit or stand for a long time do not cross legs over midline do not cross ankles or kneea |
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arthroplasty complcaitcations: Hypotension |
blood transfusions: POD 1/2 physiological cues -strict intake and output -OH alert |
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arthroplasty complications DVT prevention |
compression stockings anticoagulant therapy heparin (apTT), warfarin (PT), LMWH (Xa) -unaffected side: active/passive ROM -affected side: foot rotation and isometric exercises -early ambulation |
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pulmonary embolism syndrome |
chest pain dyspnea tachypnea tachycardia diaphoresis anxiety |
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Fat embolism syndrome |
petechial rash RR insuff cerebral involvment minor: tachycardia, fever, retinal sings, jaundice, renal sings lab: h/h low, thrombocytopenia, high ESR, fat macroglominemia |
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arthroplasty home interventions |
rasied toilet seat unobstructed walk areas saftey rails in shower/bathroom no scatter rugs: small carpet peieces don't stick to the floor |
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RA pathophys |
-antibodies from attacking healthy tissue -phagocutic activity, inflam response, inflam synovail membrane -cartialge breakdown and panes formation -fiborous and joint deformity -fiborus tissue calcification -local and systemic dysfunction |
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RA nursing assessment CM |
inflammation bilateral and symmetrical progress to other joints over years affected joints painful and stuff hard to move for 30 mins or after resting activity decreases pain and stiffness |
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RA nursing assessment early stages |
joint inflammation systemic: low grade fever, fatigue, weakness, anorexia, parathesias |
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RA late joint CM |
deformities moderate to severe pain morning stiffness |
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RA late systemic CM |
osteoporosis anemia severe fatigue weight loss subQ nodules vasculitis organ dysfunctoins |
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Sjogren's syndrome |
autoimmune destruction associated with RA and fibromyalgia sicca syndrome xerostomia |
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Ra lab and dx |
RF + increased ANA titer C3 and C4 decreased CRP high ESR high CT/MRI/Xray/Arthrocentesis |
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Pharm tx RA |
1st line: NSAIDS: asa, ibu, celecoxib 2nd line NSAID with disease modifying anti rheumatic drugs (DMARD) like methotrexate glucocorticoids biological response modifiers : neutralie tumor necrosis factor, etanercept, infliximad, adalimumab, abatacept |
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Methotrexate |
3-6weeks decrease B and T lymphocytes SE: GI, hepatic fibrosis, bone marrow suppression |
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RA nursing management goals of therapy |
decrease pain increase mobility comfort: rest, positioning, thermal therapy, supportive measures reconstructive surgery |
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OA differenees |
o65+ female 2:1 rf: aging, genetic factor dx: degenerative clinical signs: unilateral, WB joints, non systemic activity: pain increased with activity labs: ESR WNL Drugs: NSAID, acet, analgesic therapy |
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RA differences |
35-45 female 3:1 RF: autoimmune, emotional, envionrment -inflammatory -cm: bilateral, UE first, systemic -activity decrease pain -increase ESR -drug: NSAID, methotrexate, cortico, BMADS |
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SLE pathophys |
defective elimination of self reactive B cells Increase in production of antibodies damage to tissues or combine with antigens to form tissue damaging immune complexes -chronic, progressive inflam CTD lead to major organ and system failure |
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SLE nursing assesment |
physical: butterfly rash, polyarthrtitis, osteonecrosis, muscle atrophy, myaldgia -psych -organ failure -kidney is biggest prob -flare=recent sun -transient lupus like s/s post procainamide |
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SLE lab and dx |
+ ana titer increased ESR decreased C3 and C4 CBC: anemia, thrombocytopenia, leukocytosis, leukopenia biopsy only absolute for dx |
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discoid lupus erythematuous nursing managment |
only effects skin dry raised scaly patches dx: confirmed with biopsy tx: topical cortisone and skin protection |
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SLE nursing managment |
topical cortisone for face lesions steriod therapy immunosuppressive agents avoid sun exposure wear hat/clothes that shield skin sun screen SPF 30 avoid crowns alopecia is common: milk shampoos |
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Gout pathophys |
Excessive uric acid from rate crystals deposited into joints and other tissues -severe inflammation -disease of kings and king of diseases |
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Primary gout |
most common -caused my inherited problem with purine metab -uric acid production exceeds the kidneys ability to excrete -increase blood levels -25% family hx -90% middle aged men |
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Secondary Gout |
affects all ages and genders hyperureecimia due to another health problem like renal problems, diuretic therapy, crash diets, chemotherapy |
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Gout nursing assesment |
attack occurs fast 8-12 hours PE: pain in joints asymptomatic stage: unaware and no tx acute gouty arthritis: pain and inflammation, great toe: podagra chronic gout: deposits of rate crystal develop under skin and with/in major organs (renal) |
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Gout lab and dx |
hyperuricemia increased ESR and WBC chronic gout: tophi: Na urate crystal deposits, renal calculi and stones |
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Gout TX |
NSAIDS: indomethacin, naproxen acute: colchicine, antiinflammatory agent, inhibits leukocyte infilatrion se GI chronic xanthine oxidase inhibitors: allupurinal, febuxostat, probenecid, pegloticase |
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Gout nursing and medical tx |
reduce pain prevent complications prevent future attacks weight reduction nutrition, diet management |
